Provider Demographics
NPI:1740507896
Name:MANN, AMRIK S (RPH)
Entity type:Individual
Prefix:
First Name:AMRIK
Middle Name:S
Last Name:MANN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PONDCREST ROAD,
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-2814
Mailing Address - Country:US
Mailing Address - Phone:203-746-8533
Mailing Address - Fax:
Practice Address - Street 1:34 MAPLE ST
Practice Address - Street 2:2ND FLOOR PHARMACY
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3815
Practice Address - Country:US
Practice Address - Phone:203-852-2684
Practice Address - Fax:203-852-2615
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031818-1183500000X
CT0008441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist